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The ER charged him $6,589.77 for 6 stitches, cost that led his wife to avoid ER

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Re: The ER charged him $6,589.77 for 6 stitches, cost that led his wife to avoid ER

#21
post #2

Somehow everybody in this system claims they're not the ones making bank on this swindling. The doctors say they're underpaid. The hospital admin says they're underpaid. The insurance companies say they're barely covering their payouts. So who is lying?

The American insurance system has inherent efficiency problems.

Hospitals are for profit corporations. Doctors are reviewed on how much revenue they generate per patient - usually by asking for more diagnosis and treatments - which is what patients want too.

Too much admin, too little doctors. Someone should get the admin to doctor ratios at hospitals, it is nuts. A lot of admin is there to handle the insane documentation requirements, software, machinery and dealing with insurance providers.

Insurance providers have their own army of admins, talking everyday to hospital admins.

On top of this, supplies providers know that insurance is going to foot any bill. So they charge more. Insurance tries to negotiate it down but there's only so much they can do - unless they buy stuff directly from China or somewhere else.

To add, each of these institutions has their own management ladder with fatter paychecks than the doctors themselves. These folks are nothing but leeches who just need the corporate ladder to exist.

Unfortunately, the only capitalist solution out of this is to allow massive production of doctors (blocked by AMA), allow doctors to unite and form their own hospitals willy nilly (harder than you think because legal requirements are burdensome) and for insurance providers to compete in open market - as they do for cars. No more open enrollment.

Re: The ER charged him $6,589.77 for 6 stitches, cost that led his wife to avoid ER

#23
post #6
post #4

Earlier quoted context omitted.

The hospital and the doctors. Almost $500 for a tetanus shot is simply not justifiable

The doctors likely have nothing to do with how much procedures bill for. In private practice outside a hospital, they perhaps have more guilt here, but in an ER? They set the prices about as much as the janitors do.

I've had doctors in the ER bill directly out of their own practice several times. Out of network, but I've had no choice in the matter except to receive treatment or refuse treatment for life-threatening conditions.

The law here has changed since then to prohibit this kind of thing, though.

Re: The ER charged him $6,589.77 for 6 stitches, cost that led his wife to avoid ER

#24

Maybe I missed it in the article, but if he was injured on the job, shouldn't the construction company pay the bill?

From personal experience, many states dont require workers compensation for independent contractors. Now there are protections still, but it isn't as robust as employee protections, and even then in some states (like Texas), the company doesn't have to have workers compensation insurance at all, but instead can use mediation and arbitration to "take care of" injured workers.

My sister is an orderly at a nursing home in Texas, and was attacked by a patient, she was was scraped up and had to get stitches, but they wouldn't allow her to fill out a work place injury form or reimburse her for medical expenses, and instead the onsite RN stitched her up at the request of management. The company (pretty large nursing home management company) does not carry workers compensation insurance and instead uses 3rd party arbitration to handle injury "disputes"... so if you are TRULY injured, you have no real recourse than to wait days and days without treatment waiting for this third party to say they will reimburse you.

Re: The ER charged him $6,589.77 for 6 stitches, cost that led his wife to avoid ER

#25

This is absurd. Even in a country with liberal economics and "free choice" health system (however with universal care, and state regulation), the same stitches in a world-class private clinic in Santiago, Chile would cost 400 USD, before insurance . The clinics there are not the ones Americans imagine from a middle-income country, most of them have better infrastructure and doctors than the ones I know in Europe. And…

The stitches are expensive mostly because of many regulatory factors that restrict the supply of medical services and drive costs up, with the "free market" component being in how much they can charge the patients. It's the worst of both worlds in the US.

Exactly. What the US lacks is actually more liberal market in health. Less regulations and more competition.

When talking about regulations people usually mean regulating pricing and/or service quality but what actually needs to be tackled are the factors that limit competition, like: - process for opening new clinics/hospitals should have little to none restrictions - requirements for doctors (no doctors from outside can work in the US unless they complete $400k degree) - Drugs from outside countries should be allowed to be imported without FDA's approval

and so on

Re: The ER charged him $6,589.77 for 6 stitches, cost that led his wife to avoid ER

#26

This is absurd. Even in a country with liberal economics and "free choice" health system (however with universal care, and state regulation), the same stitches in a world-class private clinic in Santiago, Chile would cost 400 USD, before insurance . The clinics there are not the ones Americans imagine from a middle-income country, most of them have better infrastructure and doctors than the ones I know in Europe. And…

$400 still sounds high, to be honest.

Yes, and it would be even more expensive in Germany. But in both countries the insurance covers normally 50% of it, wherever you go. If not all. (Other sickness are covered normally 80% if not entirely whatever insurance you have)

Re: The ER charged him $6,589.77 for 6 stitches, cost that led his wife to avoid ER

#27
I'm in my mid 30s and have left fixing up some damaged teeth and my large wisdom teeth impacted for 17 years too long, this Monday I'm going to get them removed under general anaesthetic at a private hospital.

The Australian government covers hardly any dental unless your teeth have completely rotted through and are chasing other issues.

So far my costs are:

- $4500 in fillings and general dental.

- $1800 for a crown (gold).

- $350 consultation with surgeon (via zoom).

- $1100 for 30-40 minutes (max) of a theatre room for the initial operation.

- $4000 for the surgeon for 30-40 minutes.

- $450 for the anaesthetist.

- $0 for X-rays (covered under Medicare).

- $150 transport.

- $YTD medication post surgery.

- $YTD follow up dental work.

- $YTD additional surgery to cavities from the top teeth into the sinuses - this is only a maybe, it's a risk.

Total so far in the last 3 months has been over $12,000

What stand out for me is how can the surgeon charge $4000 for 30-40mins of active work, and I'm assuming a little paperwork.

Having said all that, I admitted myself to the ER earlier this year and spent the day there having a bunch of tests, didn't cost anything at all and no insurance required.

While healthcare in Australia is generally pretty decent,dental is significantly lagging behind and expensive.

Re: The ER charged him $6,589.77 for 6 stitches, cost that led his wife to avoid ER

#28
post #6
post #4

Earlier quoted context omitted.

The hospital and the doctors. Almost $500 for a tetanus shot is simply not justifiable

The doctors likely have nothing to do with how much procedures bill for. In private practice outside a hospital, they perhaps have more guilt here, but in an ER? They set the prices about as much as the janitors do.

The article mentions an accusation that doctors are “upcoding” procedures to be able to charge more.

Re: The ER charged him $6,589.77 for 6 stitches, cost that led his wife to avoid ER

#29
This is why you want to go to ConvenientMD or similar urgent care centers for anything not acutely life-threatening. It's usually faster than being seen at an ER, and costs an order of magnitude or more less - my insurance has a baseline fee of only $50 vs $600 for the ER.
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